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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100022

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John AllenNicholson Sex Male

Date of Birth June 4, 1921 Place of Birth BucklawCounty of Victoria

Name of Father Adam Nicholson MAIDEN NAME of Mother Hanna Nicholson

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Present address of Father deceased

Occupation of Father at Birth of child Mailman Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Maxine Nicholson Address of Applicant 54 Dawson St. Dartmouth Date July 29, 1983

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John AllenNicholson

Born at Bucklaw in the County of Victoria

That John AllenNicholson Whose Birth is sought to be registered was

born at Bucklaw Victoria County on June 4, 1921

My knowledge of the fact and date of such Birth is based on the following Circumstances:

1) Marriage Extract 2) Census Record 3) National Registration Record

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